Orthostatic
by StillWaters1
Summary: Sam collapsing was bad.  Sam collapsing without Dean knowing/being able to kill the reason behind it was worse.  Much worse.


Title: Orthostatic

Author: Still Waters

Fandom: Supernatural

Disclaimer: I do not own Supernatural. Just playing, with love and respect to those who brought these characters to life.

Summary: Sam collapsing was bad. Sam collapsing without Dean knowing/being able to kill the reason behind it was worse. Much worse.

Notes: Set in Season 1, between 1x15 (The Benders) and 1x16 (Shadow). As always, I hope I did the characters justice. Thank you for reading and thank you to those reviewers I am unable to respond to personally via private message. I truly appreciate your support.

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><p>"Dude, the hot water in this place <em>sucks<em>," Dean complained as he opened the bathroom door, toweling his hair and kicking muddy clothes toward the bed. "You gotta hold the dial…" he trailed off at the sight of 6'4" of mud-spattered brother asleep on the far bed. As much as he'd love to let Sam sleep, the kid was a still-damp mess and Dean knew from personal experience that the longer you let someone sleep like that, the more of a bitch it was to wake up, drag yourself to the shower, and scrub the stiff, dried muck off. He balled up the towel and launched it at Sam's chest. "Rise and shine Sammy," he bellowed across the room. "Before you dry to the bed," he added, wrinkling his nose at his own muddied jeans now crumpled on the floor near his bag.

Sam bolted awake with a strangled gasp. In one fluid, split-second motion, he went from flat on his back to standing straight up in the narrow space between the two beds.

"Wow, Sam," Dean pursed his lips, eyes wide with approval. "That's pretty…"

The word 'impressive' was cut off as Sam promptly collapsed with a dull thud.

"…graceful." Dean amended with a snort. "Even for you." He waited for Sam's head to pop up between the beds with a mixture of sheepish embarrassment and bitchy glaring at Dean's overt amusement.

It didn't happen.

Dean's entire body shifted as the teasing brother was shoved aside by the protective elder, only the trained hunter tempering the sudden, panicked movement. "Sammy?" he demanded, rushing around the bed to where Sam had disappeared.

Sam was face down, legs twisted awkwardly by the bedside table, a growing stain of blood under his left eye.

Shit.

Dean's mind began running scenarios as he attempted to wake Sam, checking his pulse and respirations, choking out a breath at finding both present. Forcing himself past the continued unresponsiveness, Dean began running practiced, shaking hands over his brother's body to check for injury before attempting to move him out of the tight space. What could take Sam down like that? The room was secure – salt lines and charms in place, EMF clear. The salt and burn had gone without a hitch except for the freaking downpour, so no pissed off spirits were left to hitch a ride. Dean cleared Sam dorsally and, supporting his neck as much as he could, shifted Sam onto his back, reaching down to untangle those inhumanly long legs. He winced at the gash over Sam's left eye, matching it to the smear on Dean's bed frame, and cringed again as his gaze returned to the unmistakable swelling of what was going to be one hell of a black eye. Nose wasn't broken, facial bones intact. He moved his hands lower. Sam had gasped when he woke up – nightmare? Vision? Ribs clear, abdomen soft. Hooking into the psychic channel again? Forearms, wrists, fingers amazingly intact for having ended up underneath him. Did Sam wake up with a headache so bad he passed out? Could some new evil sonuvabitch tie into the psychic stuff and hurt Sam even through their usual precautions? Knees, ankles, feet clear. Dean moved back to Sam's head, grabbed under his arms, and dragged him out of the narrow space so he'd have more room to work. Could the gasp have been some sort of supernatural asphyxiation? There hadn't been anything physically strangling him like back in Lawrence, but they didn't have to _see_ it in order for it to be able to hurt him. Dean double checked Sam's neck and airway. Clear. No visible swelling or bruising. Could it have been….

Sam groaned, his head lolling sluggishly.

"Sam?" Dean asked, voice a raw prayer.

Sam's face scrunched in concentration, tightening further at the pull on injured tissue, until all expression faded and he went still and silent again.

Dean grimaced with preemptive guilt. "Sorry Sammy," he whispered before rubbing his knuckles into Sam's sternum.

Sam bolted to a sitting position with a gasp, eyes widening with a choked, guttural moan.

"Whoa, Sam," Dean soothed, a mixture of apology, alarm, and relief. "Let's try and avoid a repeat performance, okay?" he put one hand behind Sam's head, the other on his chest, and gently pushed Sam back down until he was flat.

Sam lay still, breathing hard as muddy hazel squinted at Dean. "D'n?" he slurred.

Dean searched those disoriented eyes for signs of anything that wasn't his brother, even as he assured, "Yeah Sam, right here."

Sam continued to breathe in a careful, practiced rhythm, closing his eyes briefly before opening them again as his hammering pulse gradually slowed. Dean saw the disorientation pass, cleared irises tracking the room - a hunter gathering data.

Dean let out half a breath. "Sam, you with me?" he asked, trying to ignore the shakiness inherent in those words.

"Yeah," Sam's voice was breathy, but clear. He looked around again, before settling back on Dean. "I'm on the floor," he stated simply.

Dean let another fraction of breath escape in a huffed laugh. "Man, nothing gets past you, does it Sam?" he rolled his eyes even as relief at Sam's coherence flooded his chest.

Sam tried to mirror the eye roll, frowned as it pulled on impending bruising and lacerated skin, then blew out a frustrated 'I just can't win' breath – pure Sam – as the frown hurt even more. "Okay," he drew out the vowel. "I'm on the floor…_why_?"

"You tell me," Dean shrugged. "You're the one who decided to throw yourself at the carpet. Makes you look kinda desperate there, Sammy," Dean waggled his eyebrows over eyes that weren't ready to mirror the knee-jerk humor. Able to breathe now that Sam was with it, Dean busied himself with getting a better look at the laceration, pulling a bandana from his pocket and dabbing lightly at the blood. Once satisfied that it was superficial enough that he wouldn't be doing any stitching that night, Dean leaned back slightly, maintaining steady pressure.

"Huh," Sam's brows raised and he flinched with a low groan, coming to realize just how much he used those facial muscles now that every use of them hurt. He slowly began to sit up.

"Uh, what're you doing?" Dean asked, both his expression and tone classic Dean for 'have you lost your freaking mind?'

"Getting up?" Sam returned the look as if Dean was the one who had hit his head.

"Dude, the last time you 'got up' you ate concrete," Dean kicked the thin carpet for effect.

"So…we're just gonna stay on the floor?" Sam asked drily.

Dean stiffened. "Yeah Sam, until we figure out what the _hell_ we're dealing with, this is _exactly_ where we're gonna stay," he nearly shouted.

Sam bit back a surprised breath as he caught Dean's eyes and saw, under the panic and anger, the clear signs of Dean the tactician. Reviewing information, coming up with strategies.

"Okay," Sam acquiesced, slowly sitting up, palms out, both understanding and non-threatening as he showed Dean he could sit safely. "We'll sit here and figure it out," he said, reaching for the bandana. Dean hesitated for a split second, reluctant to give up the contact, but finally reneged, nodding at Sam slowly and shifting back until his right leg brushed the stiff mud at Sam's knee. Seeing Dean settle with the new arrangement, Sam got down to business. "Okay, so what've we got?" he asked, as if this were any other job.

The tension flared. "What we've _got _is you jumping out of bed like you were freaking electrocuted, then going down like Bigfoot took a shot to the head," Dean exploded.

Sam gave him a moment as the panic resurfaced. Seeing your brother go down was a fear with which Sam was equally intimate. Once Dean appeared to be receptive, Sam continued, his voice quiet, but firm. "Dean, tell me _exactly_ what you saw."

Dean deflated, recognizing Sam's tone – the same one he used when talking to victims' families. But there was no hint of condescension, no subtle 'pull it together, Dean' jab – just gentle focus, compassion, and _Sam_. Dean scrubbed a hand across his face, the other brushing Sam's leg quickly in both thanks and reassurance as he took a breath. "You were asleep when I got out of the shower. I chucked the towel at you…"

Sam's eyes shifted into a sighed, nonverbal 'nice – thanks for that.'

"…yelled 'rise and shine Sammy' before you dried to the bed," Sam watched Dean recall the exact words, always important in their work. "You shot up with this sort of strangled gasp and went straight to your feet – pretty impressive until maybe two seconds later when you dropped right on your face."

"Did I say anything?" Sam asked.

"Nope. Not a word. Not sure you were really even _awake_," Dean mused on that new realization.

"Was I…" Sam swallowed. "…was I having a nightmare?" he asked, voice small.

Dean cringed at the fear in that suddenly young tone. His protective instincts surged. "Don't think so – you were _out_," he said.

Sam nodded, his shoulders dropping as the lines of tension from that very thought began to ease.

"You remember a nightmare?" Dean asked.

Sam shook his head gingerly. "No," he said, and relief swept through both of them – he _always_ remembered.

"Okay," Sam cleared his throat, "what else?"

Dean grimaced. "I got over there, checked you out, and dragged you over here. You were out for a good minute, then kinda out of it after the sternal rub…."

Sam shot him a glare for that one.

"Hey, you weren't waking up," Dean protested, unrepentant even in the face of his whispered apology before the actual action itself. "But then you were fine and wondering why you were on the floor. Only injuries I found were the head," he gestured at the bandana Sam held, "and what's gonna be one hell of a black eye. That's it," he finished.

"Okay," Sam considered the information. "So you're thinking…"

Dean blew out a frustrated breath. "I don't know, man," he groaned heavily. "With everything that's been going on lately…"

Sam knew what he meant – there was always the potential for hunters to run into something unknown, to have to improvise on the spot when some new evil appeared, but the last few months…with Dad both missing and overly cryptic, rare supernatural creatures coming out more frequently, the two of them getting back to really being brothers again in the wake of hints of a disturbing underlying plan with Jess' death, Sam's 'shining', and the feeling of the world trying to pull them apart…...

"…it's just all screwed up," Dean summarized Sam's thoughts.

Sam nodded. "Well, what_ were_ you thinking?" he pressed on. "We've ruled out nightmares, and by extension, visions," they both let out a breath at that. "So, what else?"

Sam had never really made the connection as to why hunters were often so good at science until college. It not only came from improvising weapons and diagnostic equipment, working with varying biologies, and being their own first aid providers, but because, when it came down to it, hunting basically followed the scientific method. Since they were kids, Sam and Dean had been taught to gather data, research and compare studies, form hypotheses, and test and rework them on the way to a solution. So Sam knew that Dean already had a list of possibilities to rule out – even in a panic, he'd do it as naturally as breathing. As naturally as worrying about Sam.

With a nod, Dean began running through what had come to mind while he was assessing Sam, and together, they evaluated it with Sam's added information. No nightmares, no visions. No headache beyond the one he gave himself hitting the floor. No sense of another presence to indicate an outside force taking advantage of his abilities. No pain in his neck or throat, no memory of strangulation or threatening presence as had been so strong in Lawrence even as Sam had been graying out.

Dean tugged on Sam's wrist to check under the bandana, nodding as he saw the bleeding had almost stopped. Seeing Sam wince from the brush of the shifting fabric, Dean got up, wrapped some ice in a washcloth, and had Sam switch out the makeshift bandage for the ice bag. Sam hissed at the initial chill before relaxing as numbing relief took hold. "Thanks," Sam groaned softly.

Dean nodded, running a rough, damp hand through his hair. "Dammit Sam, what else could it be? We've ruled out the usual stuff _and_ the new weirdness. I'll look in Dad's journal later, but…" he blew out an aggravated breath, silent for a moment as he watched Sam ice his face. He squinted as a new thought came to mind. "You didn't get whacked in the head or anything that I don't know about during the job, right?" he asked, not really having considered that line of questioning as he had generally kept Sam in sight while they worked. He hadn't felt any swelling beyond the new stuff when Sam was on the floor, but they were running out of options, and it didn't really occur to Dean what it said about their lives that it was only _after _ruling out a litany of supernatural culprits, that they even _considered_ something physiological.

Sam shook his head, wincing as he forgot to adjust the movement to the injury. "No," he said honestly, shifting to straighten his back out. "Probably the easiest job we've had in awhile – not even a bruise." He glanced at Dean with one concerned eye to ensure that the same truth held for his brother.

"Yeah," Dean nodded in agreement, answering Sam's unspoken question as to his own health. "Dude, you got anything? 'Cause I'm pretty much out of ideas," he sighed, the frustration a heavy defeat.

Sam thought back over the day, trying to pinpoint anything unusual. The night before, he'd had the dream about Jess and the fire again – nothing new, just a normal nightmare about a traumatic event - no other freaky ties. It had surprised him because it'd been a couple of weeks since the last one, so he hadn't been feeling a hundred percent during the day with the fresh memory of that endless despair…..and like back then, the grief left him with no real appetite so….

Crap.

Dean saw the exact moment that thought broadcast across Sam's face. "What?" he demanded.

Sam swallowed. Dean was gonna kill him.

"Sam, _what_?" Dean pressed. He knew that look – Sam_ had_ something.

"You said I went right to my feet," Sam looked for verification.

"Yeah, just bolted from flat on your back to full attention," Dean confirmed, watching Sam warily.

"I think my blood pressure dropped," Sam said sheepishly.

Dean's eyes scrunched in a silent 'well, _that_ was random' scoff. "Okay," he stretched the second syllable. "So…what? Psychic nightmares and migraine-inducing visions come with some sort of bonus internal blood pressure monitor now?" he shot Sam a clear look, the one that said he wasn't going to get away with any half-assed explanations.

Sam rolled his eyes, sighing heavily when he had to abort the movement halfway through as the ache overrode the ice pack's pleasant numbing effect. "You know how, when you stand up too fast, sometimes you get dizzy? Vision kinda grays out?" he asked.

Dean nodded slowly. "Yeah, I'm familiar," he said slowly.

"Well, it happens because your blood pressure drops – it doesn't adjust quickly enough to the change in position," Sam explained.

"Okay, Dr. Quinn," Dean still had that look fixed on Sam, despite the usual reflexive insult to his brother's manhood. "So, what caused it? You're not bleeding anywhere major, so it's not like you were down a couple of pints," Dean immediately connected the information to a long line of previous, hemorrhaging experience.

Sam shrugged gingerly. "Lots of things could cause it," he offered.

"Not what I asked, Sam," Dean saw right through him. "You_ know_ what did it, so quit stalling and spit it out," he warned, panic warring with irritation.

Sam embraced the discomfort as his face twisted into the familiar lines of classic Sam Winchester guilt.

"Sam…." Dean's eyes sparked, immediately reading the change in Sam's expression.

Sam sighed. "I had the dream about Jess last night," he said softly.

Dean's face fell. "Aww, Sammy," he sighed. "You were doin' good there for awhile." After three days of no sleep a week or two after Bloody Mary, Dean had decided that Sam's "lollipops and candy canes" dismissal was no longer acceptable and started making Sam talk about the dreams. "Why didn't you say anything?" he asked. No recrimination, just support.

Sam shrugged. "It wasn't…different," he justified, Dean immediately understanding the meaning. "So…I don't know. I guess it brought everything back and I was just focusing on the job and I wasn't really hungry so…" he began to rush the end as the guilt escalated.

Dean's eyes narrowed even as they widened in understanding, his mind going back through the day and realizing the truth. "You didn't eat all day," the recollection was a tempered accusation, as he remembered the days after Jess where he practically had to force feed Sam nutritional shakes to get through the grief-induced inappetance. "And you drank…..what? Maybe half a cup of coffee?" he thought aloud.

"Dean, I'm sorry, I…"

"_Dammit_ Sam!" Dean finally exploded. "Like there isn't _enough_ out there trying to take us out? You need to go and…" his voice caught as he trailed off, scrubbing his hands through his hair, then down his face as his breath hitched. Sam moved the ice, desperate to find Dean's eyes.

And saw it all.

This wasn't about recklessness – Sam saw no admonishment even after Dean's words. This was about guilt – a guilt that rivaled Sam's own. Guilt, anger, and fear. Guilt that Dean hadn't noticed Sam not eating, that he hadn't protected Sam from that fall, that he hadn't recognized the resurgence in grief and acted sooner. Anger at how something so trivially _medical_ had hurt Sam, at how he had missed it because their work only led to one line of thinking, at whatever had done this to their family. And fear – the fear of seeing someone you love, the only thing you have, collapse to the floor, hurting…and not knowing what caused it, how to fight back, what to kill. Of not having that easy solution. Fear of what could have happened had Sam fallen another way. Fear that this, although not supernatural, was a reminder that there were some things he couldn't protect Sam from. And through all those warring emotions, a deeper truth - because what it really came down to, what _Dean _really came down to, was the vow he had taken when he accepted his infant brother's safety in the heat of life-altering flames. Watch out for Sam. With Dad gone and the world turning upside down, it was all he had to hold onto. And because of Sam's stupidity, Dean felt like he had failed. Failed Sam. Failed Dad. Failed everything that he _was_.

Sam read it all as he held Dean's eyes, watching blurry green struggle for control as the guilt won out again, mirrored in both brothers' faces.

Catholic guilt had nothing on the Winchesters.

Sam poured all his understanding, apology, gratitude, and promise into his own eyes, and sat quietly until Dean was ready to hear it in the silence. Sam felt the moment that Dean understood, as the room suddenly breathed again with his brother's shaky sigh.

"First thing tomorrow, we're stocking up on the Ensure again," Dean's voice was thick.

Sam nodded in agreement.

"And you're gonna start telling me about _any_ dreams – 'different' or not," he added.

Sam cringed at the perceived invasion of privacy. "Dean…" he protested.

"No, Sam," Dean insisted, throwing a hand out as his lower lip fought the stubborn tremor that revealed just how freaked out he really was. "This isn't negotiable." He swallowed hard, pulling himself together, and Sam saw the fear flare briefly before he calmed – and offered a compromise. "Just until you're okay again," Dean amended softly.

_Until I know the grief and memories won't kill you – that at least one threat is under control._

Sam's heart ached at Dean's concern…and wondered what he had done to deserve such devotion, even as he mirrored it right back. "Deal," he agreed, wincing with the resulting nod.

"Okay," Dean blew out a breath, steadying his voice as he slapped Sam's leg with one hand and guided the ice back to his face with the other. "Now, you think you can shower without injuring yourself any more tonight?" he asked, casting a critical eye over Sam's posture and one available eye.

"Let's see," Sam decided, holding out a hand. After a second's hesitation, Dean pulled him to a standing position, watching carefully as Sam swayed briefly, blinking back the darkness, before giving Dean a thumbs up. "Yep, we're good," Sam confirmed as he finished his self-assessment. "But I'll keep it lukewarm just to be safe."

Dean's eyes softened with that tacit, understanding compromise. "Lukewarm's not gonna be a problem," he snorted, tilting his head toward the bathroom. "Like I tried to tell you before, the hot water here _sucks_. Unless you wanna shower with one hand, it's just easier to take what you get."

Sam's lips twitched at the potential in Dean's choice of words.

Dean's face lit up. "Sam-my! That's my boy!" he praised with a grin. "We'll get that college brain back in the gutter again sooner than I thought." He slapped Sam's arm and put a hand out for the ice. "Now go shower – I gotta think."

Sam frowned as he handed Dean the washcloth and slowly moved to his bag for a change of clothes. "About what?" he asked.

"About what badass story we can tell the waitress when she sees your face," Dean stood up with that reminder and checked Sam's head, satisfied that it clotted. "Don't scrub over there," his fingers ghosted around the laceration. "It's closed up enough that it shouldn't need stitches – we'll put a bandage on it when you don't look like one of those mud spas gone wrong."

Sam shook his head carefully with a huffed laugh. "Fine," he said, before picking up Dean's previous thought. "What waitress?"

"The one at the diner down the street – you know, the one we're going to as soon as you look human again."

"Dean, it's two in the morning," Sam pointed out.

"And it's a twenty-four hour diner," Dean mimicked Sam's tone. "I'm _starving_ Sam, and the sign said 'best pancakes in town.'" Dean looked at him as if no further explanation was necessary.

"Dude, we're in the middle of nowhere, Ala_bama_. Population's only like two hundred people. I doubt there's much to compare it _to_," Sam snorted.

Dean stared at him with mock seriousness. "Keep talking Sam, and I'll just tell her the truth – 'bout how you face-planted on a motel room floor like the big, twisted Gumby you really are."

Sam's head drew back in surprise. "Gumby?" he asked mildly.

"More like Gumby if he was made of freaking concrete," Dean flexed his back as strained muscles protested moving Sam earlier. He looked back at Sam's face. "What?" Dean asked defensively. "You used to watch that show."

"No I didn't," Sam insisted.

"Yeah you did," Dean pushed back with his 'I'm older, so I remember' voice.

"Only because_ you_ put it on for yourself," Sam countered.

Dean paused, lips quirked in acknowledgement. "Yeah, well, you still watched it," he decided.

Sam just sighed and headed for the door. "Whatever, Pokey," he muttered under his breath.

"I heard that," Dean called out. "Every smartass comment's just gonna take you one step further from the epic tale of how you fought three armed dudes about to kill a basketful of kittens."

Sam burst out laughing, ignoring the pull on his puffy face as he embraced the full-body response and allowed his head to fall back in rare, uninhibited joy. He left the door open a crack - just to let the steam out, totally not for Dean's comfort – and began to undress.

Dean flopped down on the desk chair, smile softening at the cracked door. He leaned back on two legs, the echo of Sam's laughter overriding the haunting memory of him hitting the floor. He pulled out his wallet and began flipping through the cards, grinning at Sam's 'what the fuck' noise as the shower dial squeaked.

He snorted back a laugh at a recent Visa mixed into his old standbys. Sam must have applied for this one and slipped it in there, knowing Dean would appreciate the memories behind the name.

Dean leaned forward, dropping the chair's front legs with a satisfying jolt as he listened to the familiar sounds of his brother's routine. He tapped the card on the table to the rhythm of the squeaking bed in the next room as his thoughts wandered amidst the musty tendrils of cigar smoke creeping under the front door.

He glanced at the card again with a chuckle, remembering late nights in similar motel rooms, laughing with a teenaged Sam as they read aloud from yet another interrupted high school textbook.

Sometimes a cigar was just a cigar. And sometimes an idiot little brother passing out was just an idiot little brother who didn't think to eat.

Dean dropped the card on the table with a grin, stood with a satisfied stretch, and sauntered over to his bag to dig out a clean shirt.

Yep, definitely a good night for chocolate chip pancakes.

And for Schlomo Freud to pick up the tab.

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><p><span>Notes:<span>

- The title refers to the medical term for Sam's blood pressure drop, which is "orthostatic hypotension."

- "Dr. Quinn" refers to the 1990s TV series "Dr. Quinn, Medicine Woman."

- "Gumby" and his orange pony sidekick "Pokey" are from the stop-motion clay animation series "Gumby", some episodes of which aired during the 1980s and '90s.

- "Ensure" is a nutritional supplement shake, often used for people with poor appetites or nutritional deficiencies.

- "Schlomo" is the middle name of Sigmund Freud, the Austrian founder of psychoanalysis.


End file.
